Provider Demographics
NPI:1588334650
Name:HACKETT, AMBER (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:GEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3132 SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3521
Mailing Address - Country:US
Mailing Address - Phone:727-709-2169
Mailing Address - Fax:
Practice Address - Street 1:2240 TWELVE OAKS WAY STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6970
Practice Address - Country:US
Practice Address - Phone:727-709-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW174191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical